多发性骨髓瘤57例疗效分析

Efficacy of 27 patients with multiple myeloma

目的 研究以硼替佐米为主的方案和MPT方案治疗初治、复发难治多发性骨髓瘤（MM）的疗效及安全性.方法 27例患者接受以硼替佐米为主的方案化疗（硼替佐米组）,中位治疗3个（1～5个）疗程,30例患者接受MPT方案化疗（MPT组）.采用欧洲血液和骨髓移植工作组（EBMT）及WHO标准判断疗效及不良反应.结果 硼替佐米组：1个疗程后有效21例（77.8%）;治疗结束后有效24例（88.8%）,初治组及复发/难治组有效分别为15、9例,总有效率（ORR）分别为94.0%、82.0%.MPT组：治疗结束后有效15例（50.0%）,初治组有效12例（44.0%）,复发/难治组有效3例.治疗结束后硼替佐米组对初治及复发/难治患者的ORR优于MPT组（P＜0.05）.硼替佐米组周围神经病变、带状疱疹及Ⅲ～Ⅳ度血小板减少10例（37.0%）、7例（26.0%）、10例（37.0%）,高于MPT组,但MPT组Ⅲ～Ⅳ度贫血21例（70.0%）,高于硼替佐米组.硼替佐米对于肾功能异常及肾功能正常患者疗效相近,各种不良反应无明显增加.MPT组4例肾功能异常患者,3例在5个周期治疗后血清肌酐水平降至正常.结论 以硼替佐米为主化疗方案相对MPT方案治疗MM更为有效,初治、复发/难治及肾功能异常患者均可受益,且不良反应轻微,患者耐受性好.

Objective To evaluate the efficacy and safety of bortezomib-based chemotherapy and MPT regimen in the MM patients who were newly diagnosed or relapsed/refractory. Methods Twenty-seven MM patients were treated with bortezomib-based chemotherapy, median cycles：3 （range 1-5 cycles）. Other 30patients received MPT chemotherapy. EBMT and WHO criteria were used to evaluate the therapeutic effects and the adverse effects, respectively. Results Bortezomib group： 21 patients （77.8 %） showed effects after the first cycle chemotherapy and 24 patients （88.8 %） showed effects after the whole therapy. In wich, 15 patients（94.0 %） and 9 patients （82.0 %） were newly diagnosed and relapsed/refractory, respectively. MPT group： 15patients （50.0 %） showed effects after the whole therapy. In wich, 12 patients （44.0 %） were newly diagnosed.And the other 3 were relapsed/refractory patients. The ORR in Bortezomib group was better than MPT group （P 〈0.05）. The incidence of peripheral neuropathy, herpes and Ⅲ - Ⅳ grade thrombocytopenia in the bortezomib group was 10 patients （37.0 %）, 7patients （26.0 %）, 10 patients （37.0 %） respectively,and they were more common than MPT group, but the incidence of Ⅲ-Ⅳgrade anemia was 21 patients （70.0 %） and more comumom in the MPT group. The theraputic efficacy of bortezomib for renal insufficiency and normal renal function patients was similar, and no significant increase in all kinds of adverse effects. In MPT group,there were 4 patients with renal insufficiency, the serum level of creatinine in the 3 patients returned to normal after 5 cycles therapy. Conclusion Bortezomib-based chemotherapy is more effective than MPT regimen in the treatment of MM. The newly diagnosed, relapsed/ refractory and with renal insufficiency patients all can benefit from it. The adverse effects are mild and with better tolerance.